Thursday, March 30, 2017

Januscare has two faces

This doesn’t “prove” that it was the Affordable Care Act that caused this jump upwards in overdose rates in counties in “blue” Medicaid expansion states. As I’ve said before, I don’t think it was purely the Medicaid expansion itself that did it- more the full-court press to enroll young people in these states, with the knock-on effect of a subset of young people realizing they could use their insurance for pills (whether to resell or to use themselves.) Nor, needless to say, does this mean that the Affordable Care Act was a “bad idea”- it just means there are costs and benefits to the policy, and some of the biggest costs were those not scoped out in advance.

But this appears to me to be reasonably strong evidence that something went wrong, and also that, even if the majority of overdoses are now from heroin and fentanyl, prescriptions for opiates still need to be looked at very carefully.

And, of course, that public policy, like Janus, always has two faces.

All change involves winners and losers and too many (most?) policies are justified by solely by counting the winners and ignoring the losers.